单次右美托咪啶注射对甲状腺手术患者全麻复苏期呛咳和血流动力学的影响
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摘要
目的观察单次使用右美托咪啶对行甲状腺手术患者全身麻醉(全麻)复苏期呛咳和血流动力学的影响。方法选取2016年3月至2017年9月四川简阳市人民医院收治的美国麻醉医师协会分级Ⅰ～Ⅱ级在全麻下择期行甲状腺切除术患者90例,根据计算机软件编排1～90的随机数字分为右美托咪啶组(D组)和对照组(C组),每组45例。2组患者均采用统一的全麻方案,在手术结束前分别给予右美托咪啶0.5μg/kg或生理盐水。观察2组患者复苏期呛咳的发生、围手术期血流动力学[患者入室后(T0)、给予右美托咪啶/生理盐水前(T1)、给予后即刻(T2)、第1次睁眼(T3)、拔管时(T4)、进入麻醉后复苏室(PACU)后5min(T5)、出PACU(T6)的平均动脉压(MAP)、心率(HR)]等变化。结果 D组患者发生呛咳和严重呛咳人数,拔管前、拔管中呛咳程度分级均明显低于C组,苏醒时间、拔管时间均明显长于C组,T4时Ramsay镇静评分明显高于C组,发生血压异常者明显少于C组,T2时MAP明显低于C组,T3～T5时HR及MAP均明显低于C组,差异均有统计学意义(P<0.05);2组患者T4时、拔管后5min自主呼吸频率和患者在PACU停留时间,以及低氧合、心动过缓、屏气、喉痉挛、再次手术、术后恶心及呕吐发生情况比较,差异均无统计学意义(P>0.05)。结论甲状腺手术患者全麻后单次使用右美托咪啶能降低复苏期呛咳发生率及其严重程度,能稳定复苏期血流动力学,不增加麻醉后并发症的发生。
Objective To observe the effect of single use of dexmedetomidine on bucking and hemodynamics during general anesthetic recovery period in the patients undergoing thyroid operation.Methods Ninety ASA Ⅰ-Ⅱ patients undergoing elective thyroidectomy under general anesthesia in the Jianyang Municipal People′s Hospital were selected and divided into the dexmedetomidine group(group D)and control group(group C)according to the 1-90 random numbers compiled by the computer software.The two groups adopted the uniform general anesthesia scheme.0.5μg/kg dexmedetomidine and normal saline were respectively given before operation end.The bucking occurrence,perioperative hemodynamic changes such as HR,MAP and RR after entering the operation room(T0),before giving dexmedetomidine/normal saline(T1),immediately after giving(T2),first time opening eyes(T3),at extubation(T4),at 5 min after entering the postanesthsia care unit(PACU,T5)and exit from PACU(T6)were observed in the two groups.Results The number of bucking occurrence and severe bucking,bucking grade before extubation and during extubation in the group D were significantly lower than those in the group C,while the recovery time and extubation time were longer than those in the group C,the Ramsay sedation score at T4 was significantly higher than that in the group C,the cases of blood pressure abnormal occurrence were significantly less than those in the group C,MAP at T2 was significantly lower than that in the group C,HR and MAP at T3-T5 were significantly lower than those in the group C,and the differences were statistically significant(P<0.05);the autonomous respiration frequency at T4 and at T5 min after extubation,PACU stay duration,low oxygenation,bradycardia,breath holding,laryngospasm,reoperation and postoperative nausea and vomiting had no statistical differences between the two groups(P>0.05).Conclusion The single use of dexmetomidine after general anesthesia in the patients with thyroidectomy can reduce the occurrence rate and severity of bucking during recovery period,can stabilize the hemodynamics during recovery period without increasing the complication occurrence after anesthesia.
Objective To observe the effect of single use of dexmedetomidine on bucking and hemodynamics during general anesthetic recovery period in the patients undergoing thyroid operation.Methods Ninety ASA Ⅰ-Ⅱ patients undergoing elective thyroidectomy under general anesthesia in the Jianyang Municipal People′s Hospital were selected and divided into the dexmedetomidine group(group D)and control group(group C)according to the 1-90 random numbers compiled by the computer software.The two groups adopted the uniform general anesthesia scheme.0.5μg/kg dexmedetomidine and normal saline were respectively given before operation end.The bucking occurrence,perioperative hemodynamic changes such as HR,MAP and RR after entering the operation room(T0),before giving dexmedetomidine/normal saline(T1),immediately after giving(T2),first time opening eyes(T3),at extubation(T4),at 5 min after entering the postanesthsia care unit(PACU,T5)and exit from PACU(T6)were observed in the two groups.Results The number of bucking occurrence and severe bucking,bucking grade before extubation and during extubation in the group D were significantly lower than those in the group C,while the recovery time and extubation time were longer than those in the group C,the Ramsay sedation score at T4 was significantly higher than that in the group C,the cases of blood pressure abnormal occurrence were significantly less than those in the group C,MAP at T2 was significantly lower than that in the group C,HR and MAP at T3-T5 were significantly lower than those in the group C,and the differences were statistically significant(P<0.05);the autonomous respiration frequency at T4 and at T5 min after extubation,PACU stay duration,low oxygenation,bradycardia,breath holding,laryngospasm,reoperation and postoperative nausea and vomiting had no statistical differences between the two groups(P>0.05).Conclusion The single use of dexmetomidine after general anesthesia in the patients with thyroidectomy can reduce the occurrence rate and severity of bucking during recovery period,can stabilize the hemodynamics during recovery period without increasing the complication occurrence after anesthesia.
引文
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[5]孙申,黄绍强.不同剂量右美托咪啶预防舒芬太尼诱发患者全麻诱导期间呛咳反应的可行性[J].中华麻醉学杂志,2011,31(5):539-541.
[6]PARASHCHANKA A,SCHELFOUT S,COPPENS M.Role of novel drugs in sedation outside the operating room:dexmedetomidine,ketamine and remifentanil[J].Curr Opin Anaesthesiol,2014,27(4):442-447.
[7]LILI X,JIANJUN S,HAIYAN Z.The application of dexmedetomidine in children undergoing vitreoretinal surgery[J].J Anesth,2012,26(4):556-561.
[8]LAM F,LIN YC,TSAI HC,et al.Effect of intracuff lidocaine on postoperative sore throat and the emergence phenomenon:a systematic review and meta-analysis of randomized controlled trials[J].PLoS One,2015,10(8):e0136184.
[9]秦培顺,刘华程,黄静,等.右美托咪啶对小儿心导管术全麻及苏醒质量的影响[J].中国临床药理学杂志,2015,31(5):326-329.
[10]RYU JH,LEE SW,LEE JH,et al.Randomized double-blind study of remifentanil and dexmedetomidine for flexible bronchoscopy[J].Br JAnaesth,2012,108(3):503-511.
[11]MIKAMI M,ZHANG Y,KIM B,et al.Dexmedetomidine′s inhibitory effects on acetylcholine release from cholinergic nerves in guinea pig trachea:a mechanism that accounts for its clinical benefit during airway irritation[J].BMC Anesthesiol,2017,17(1):52.
[12]KIM SY,KIM JM,LEE JH,et al.Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery[J].Br J Anaesth,2013,111(2):222-228.
[13]崔旭蕾,马满娇,胡艳君,等.瑞芬太尼与右美托咪定用于预防全麻苏醒期呛咳反射及血流动力学波动的比较[J].基础医学与临床,2015,35(6):812-816.
[2]AOUAD MT,AL-ALAMI AA,NASR VG,et al.The effect of low-dose remifentanil on responses to the endotracheal tube during emergence from general anesthesia[J].Anesth Analg,2009,108(4):1157-1160.
[3]CHANG CH,LEE JW,CHOI JR,et al.Effect-Site concentration of remifentanil to prevent cough after laryngomicrosurgery[J].Laryngoscope,2013,123(12):3105-3109.
[4]CHOI EM,PARK WK,CHOI SH,et al.Smooth emergence in men undergoing nasal surgery:the effect site concentration of remifentanil for preventing cough after sevoflurane-balanced anaesthesia[J].Acta Anaesthesiol Scand,2012,56(4):498-503.
[5]孙申,黄绍强.不同剂量右美托咪啶预防舒芬太尼诱发患者全麻诱导期间呛咳反应的可行性[J].中华麻醉学杂志,2011,31(5):539-541.
[6]PARASHCHANKA A,SCHELFOUT S,COPPENS M.Role of novel drugs in sedation outside the operating room:dexmedetomidine,ketamine and remifentanil[J].Curr Opin Anaesthesiol,2014,27(4):442-447.
[7]LILI X,JIANJUN S,HAIYAN Z.The application of dexmedetomidine in children undergoing vitreoretinal surgery[J].J Anesth,2012,26(4):556-561.
[8]LAM F,LIN YC,TSAI HC,et al.Effect of intracuff lidocaine on postoperative sore throat and the emergence phenomenon:a systematic review and meta-analysis of randomized controlled trials[J].PLoS One,2015,10(8):e0136184.
[9]秦培顺,刘华程,黄静,等.右美托咪啶对小儿心导管术全麻及苏醒质量的影响[J].中国临床药理学杂志,2015,31(5):326-329.
[10]RYU JH,LEE SW,LEE JH,et al.Randomized double-blind study of remifentanil and dexmedetomidine for flexible bronchoscopy[J].Br JAnaesth,2012,108(3):503-511.
[11]MIKAMI M,ZHANG Y,KIM B,et al.Dexmedetomidine′s inhibitory effects on acetylcholine release from cholinergic nerves in guinea pig trachea:a mechanism that accounts for its clinical benefit during airway irritation[J].BMC Anesthesiol,2017,17(1):52.
[12]KIM SY,KIM JM,LEE JH,et al.Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery[J].Br J Anaesth,2013,111(2):222-228.
[13]崔旭蕾,马满娇,胡艳君,等.瑞芬太尼与右美托咪定用于预防全麻苏醒期呛咳反射及血流动力学波动的比较[J].基础医学与临床,2015,35(6):812-816.
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